Presentation
Complaints of left hemiscrotal pain post trauma -hit by ball during games. Ultrasound to rule out fracture testis or left varicoceles.
Patient Data
Serpiginous multiple anechoic vascular structures (varicoceles) are noted within the left hemiscrotal ipsilateral pampiniform plexus and on valsalva maneuver, they measure up to 4 mm in diameters. The left medial main renal vein is diffusely uniformly engorged (measuring up to 10.1 mm in diameter) with it's proximal end partially entrapped between a narrowed superior mesenteric and abdominal aortic space. The superior mesenteric artery -abdominal aortic angle of 15° noted is relatively narrowed.
The bilateral mediastinal testes are mildly prominent with discrete anechoic cystic foci accompanied with a tiny left intra-testicular upper pole (para-mediastinal testis) simple anechoic cyst, suggesting early tubular ectasia of the rete testes bilaterally.
Case Discussion
Unilateral left hemiscrotal venous varicoceles with positive sonographic features pointing towards nutcracker phenomenon. The aorto-mesenteric arteries' angle of 15° is narrowed and most likely contributing to left main renal venous partial entrapment hence the syndromic left sided gonadal varicocele (grade IV).
No post traumatic testicular fractures or contusions identified bilaterally save for the vermiform varices and the bilateral features of early tubular ectasia of the rete testes appreciated.
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